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Hello! I am an APN with a billing issue and I wanted to write to see if any of you have had Similar dealings with or could provide me with any information.
I work in an OP dialysis center, so quite a few of my patients have medicare primary and then a secondary such as Paramount, Anthem or Medical Mutual. In normal billing for my services, medicare pays its portion and then the rest goes to the secondary -- and the balance is paid from the secondary. -- I have patients that have MED MUTUAL secondary and it is ONLY from the Auto workers contract with Med. Mutual -- they ALWAYS deny payment of the secondary in this manner stating that they "Don't allow services by an advanced practice nurse" So, therefore we don't get paid except for what medicare has already paid. The amount that is lost is around 45.00 per patient-- which is not huge .. but seems unfair to me. I realize that the issue is not with Medical Mutual per say but rather with the contract that Med Mutual has with the auto- workers. Can you offer me any suggestions as to how to over come this issue? I appreciate your time and help.
If you have a name of someone I should contact, please let me know!
Thanks so much! Angie |